Provider Demographics
NPI:1578563177
Name:BLAIZE, LEO PAUL III (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:PAUL
Last Name:BLAIZE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 7000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-8829
Mailing Address - Fax:225-765-8283
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 7000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-8829
Practice Address - Fax:225-765-8283
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-01-14
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Provider Licenses
StateLicense IDTaxonomies
LA015394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110043365OtherRAILROAD MEDICARE
LA1327891Medicaid
LA5L5957881Medicare PIN
LAB61385Medicare UPIN
LA1327891Medicaid